Severe Hypoglycemia: Warning Signs and What to Do Immediately Severe hypoglycemia, or critically low blood sugar, is a dangerous condition that requir...

Severe Hypoglycemia: Warning Signs and What to Do Immediately

Severe hypoglycemia, or critically low blood sugar, is a dangerous condition that requires immediate attention. It occurs when your blood glucose levels drop to a point where you can't treat yourself and need assistance from another person. Understanding the warning signs of severe hypoglycemia and knowing how to react can be life-saving, particularly for individuals with diabetes who are on insulin or certain oral medications. This article provides a detailed overview of the condition, its signs, and critical steps to take immediately.

What is Severe Hypoglycemia?

Hypoglycemia is characterized by abnormally low levels of glucose (sugar) in the blood. This is particularly common in individuals with diabetes, as their body's insulin production or medication can sometimes cause blood sugar to drop too low. Severe hypoglycemia happens when the blood glucose level plummets so drastically that the individual is unable to treat it independently.

Normal blood sugar levels typically range between 70 mg/dL and 140 mg/dL, depending on when you last ate. Hypoglycemia is generally defined as a blood sugar level below 70 mg/dL. However, severe hypoglycemia isn't always defined by a specific number; instead, it's defined by the individual's inability to treat themselves due to cognitive impairment or unconsciousness.

Who Is at Risk?

Several factors increase the risk of severe hypoglycemia:

Diabetes: Primarily those using insulin or sulfonylureas (medications that stimulate insulin release from the pancreas).
Skipping Meals: Irregular meal schedules can disrupt blood sugar control.
Excessive Exercise: Physical activity can deplete glucose stores, especially without adequate carbohydrate intake.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose.
Kidney or Liver Disease: Impaired organ function can affect glucose metabolism and regulation.
Certain Medications: Some drugs can interact with diabetes medications, increasing the risk.

Recognizing the Warning Signs of Severe Hypoglycemia

Early recognition of the symptoms of hypoglycemia is critical to preventing it from progressing to a severe state. However, when hypoglycemia becomes severe, the individual may not be able to recognize these signs in themselves, making it imperative for others to be aware.

Initial Warning Signs:

Shakiness or Trembling: A common physical manifestation of low blood sugar.
Sweating: The body's attempt to regulate temperature due to hormonal changes.
Rapid Heartbeat (Palpitations): Adrenaline release causes an increased heart rate.
Anxiety or Nervousness: Feelings of unease or agitation.
Irritability or Confusion: Altered mental state as the brain lacks sufficient glucose.
Lightheadedness or Dizziness: Reduced blood flow to the brain.
Hunger: The body signaling the need for glucose.
Tingling or Numbness of the Lips, Tongue, or Cheeks: Neurological symptoms due to glucose deprivation.

Signs of Severe Hypoglycemia:

As hypoglycemia worsens, the symptoms become more pronounced and debilitating:

Inability to Concentrate or Confusion: Significant cognitive impairment.
Slurred Speech: Difficulty articulating words clearly.
Blurred or Double Vision: Visual disturbances due to impaired brain function.
Seizures: Involuntary muscle contractions resulting from neurological stress.
Loss of Consciousness: Unresponsiveness to stimuli.
Combativeness or Uncooperative Behavior: Unexpected and potentially dangerous actions.

What To Do Immediately During a Severe Hypoglycemic Episode

Acting swiftly and appropriately during an episode of severe hypoglycemia is crucial to preventing long-term complications or fatality. Here are the steps to take:

Assess the Situation:
- Determine Awareness: Is the person conscious and able to respond?
- Look for Medical Identification: Check for a medical ID bracelet or necklace indicating diabetes.
- Do Not Administer Anything by Mouth If the Person is Unconscious or Having Seizures:
- Risk of Choking: Trying to give food or drink can lead to choking.
- Administer Glucagon Immediately:
- Glucagon: Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. It is available as an injectable medication or a nasal spray.
- How to Administer Glucagon Injection:
  - Follow the instructions provided with the glucagon kit.
  - Typically, it involves mixing the glucagon powder with the diluent.
  - Inject the solution into the thigh, arm, or buttock.
    - How to Administer Glucagon Nasal Spray:
  - Follow the instructions provided with the nasal glucagon.
  - Administer one spray into one nostril.
    - Call for Help:
  - Call emergency services (911 in the US) immediately, regardless of whether the person regains consciousness after glucagon administration. Glucagon's effects are temporary, and professional medical attention is necessary.
  - Inform the emergency responders that the person is experiencing severe hypoglycemia and has been given glucagon.
  - Position the Person on Their Side (Recovery Position):
- Prevent Choking: This helps prevent aspiration if the person vomits.
  Related reading: The Complete Guide To Control Of Blood Glucose Levels
- Stay with the Person Until Medical Help Arrives:
- Monitor: Keep monitoring their breathing and responsiveness.
- Provide Information: Be ready to provide medical responders with information about the situation, including when the episode began, any known medical conditions, and what actions you have taken.
- If the Person Regains Consciousness:
- Provide a Fast-Acting Carbohydrate: Once they are fully conscious and able to swallow, give them a quickly absorbable carbohydrate source, such as:
  Related reading: Fasting Blood Glucose Test How To Prepare For Accurate Results
  - Glucose tablets or gel
  - Fruit juice
  - Regular (non-diet) soda
  - Honey or sugar
- Follow with a Long-Acting Carbohydrate: After the initial fast-acting carbohydrate, give them a more substantial snack, such as crackers with peanut butter or a piece of fruit with cheese, to help stabilize their blood sugar levels.

Glucagon Dosage Guidelines:

| Age/Weight | Glucagon Dose | | :----------------------------- | :---------------- | | Adults and Children over 20kg | 1 mg | | Children under 20kg | 0.5 mg |

Important Note: Even if the person responds to glucagon and recovers consciousness, it is imperative to seek professional medical evaluation. The underlying cause of the hypoglycemia needs to be identified and addressed to prevent future episodes.

Preventing Severe Hypoglycemia

Prevention is the best strategy for managing severe hypoglycemia. Education and proactive management are key.

Key Preventive Strategies:

Regular Blood Sugar Monitoring:
- Frequency: Check blood sugar levels regularly, especially before meals, after exercise, and at bedtime.
- Tools: Use a blood glucose meter or continuous glucose monitor (CGM) to track trends and patterns.
- Consistent Meal Timing:
- Avoid Skipping Meals: Eat meals and snacks at consistent times each day.
- Balanced Diet: Focus on a balanced diet with adequate carbohydrates, proteins, and healthy fats.
- Medication Management:
- Work with Healthcare Provider: Regularly review diabetes medications with a healthcare provider.
- Adjust Doses: Adjust insulin or oral medication dosages as needed based on blood sugar levels and activity levels.
- Exercise Precautions:
- Monitor Blood Sugar During Exercise: Check blood sugar before, during, and after physical activity.
- Carry a Snack: Have a carbohydrate-rich snack available during exercise to prevent hypoglycemia.
- Adjust Insulin Doses: Adjust insulin doses as necessary on days with increased physical activity.
- Alcohol Moderation:
- Drink with Food: If consuming alcohol, do so with food to slow down glucose absorption.
- Monitor Blood Sugar: Check blood sugar levels more frequently when drinking alcohol.
- Education and Awareness:
- Educate Family and Friends: Teach family members, friends, and coworkers how to recognize the signs of hypoglycemia and administer glucagon.
- Wear Medical Identification: Wear a medical ID bracelet or necklace indicating diabetes and any other relevant medical information.
- Carry Emergency Supplies: Always carry a source of fast-acting carbohydrates and glucagon.
- Develop a Hypoglycemia Action Plan:
- Consult Healthcare Provider: Work with a healthcare provider to create a personalized hypoglycemia action plan.
- Include Instructions: Include detailed instructions on how to manage hypoglycemia, including when to check blood sugar, what to eat or drink, and when to seek medical attention.

Living with the Risk of Severe Hypoglycemia

Living with the risk of severe hypoglycemia can be anxiety-provoking, but with the right strategies, you can mitigate the risk and live a full and active life.

Tips for Managing Anxiety:

Cognitive Behavioral Therapy (CBT): CBT can help you challenge negative thoughts and develop coping strategies.
Support Groups: Joining a support group can provide emotional support and practical advice from others living with diabetes.
Mindfulness and Relaxation Techniques: Practices such as meditation, yoga, and deep breathing can help reduce anxiety and improve overall well-being.

Key Takeaways for Preventing Severe Hypoglycemia:

Consistent monitoring of blood glucose levels is crucial.
Adherence to a balanced diet and regular meal times.
Careful medication management in coordination with a healthcare provider.
Awareness and education of family, friends, and coworkers regarding hypoglycemia and glucagon administration.
Preparation and quick action during hypoglycemic events can save lives.

Conclusion

Severe hypoglycemia is a serious condition that demands immediate recognition and action. By understanding the warning signs of severe hypoglycemia and knowing the proper steps to take, you can help protect yourself or someone you know from potentially life-threatening consequences. Emphasizing preventative measures, such as consistent blood sugar monitoring, careful medication management, and proactive education, is crucial for minimizing the risk of severe hypoglycemic episodes. Remember, prompt and appropriate intervention can significantly improve outcomes and ensure a safer, healthier life for individuals at risk. Always consult with a healthcare provider for personalized advice and treatment options.